Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2018; 9(10): 198-202
Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.198
Reducing costly falls after total knee arthroplasty
Surajudeen Adebola Bolarinwa, Wendy Novicoff, Quanjun Cui
Surajudeen Adebola Bolarinwa, Wendy Novicoff, Quanjun Cui, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA 22903, United States
Author contributions: Bolarinwa SA, Novicoff W and Cui Q contributed to the paper; all authors have approved this manuscript prior to submission and believe that this manuscript represents honest work.
Institutional review board statement: At our institution, this study meets criteria for exemption from IRB review.
Informed consent statement: Informed consent is not necessary, for this is a quality improvement study.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Surajudeen Adebola Bolarinwa, MD, Doctor, Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C Hunt Dr. #300, Charlottesville, VA 22903, United States. sb3dv@hscmail.mcc.virginia.edu
Telephone: +1-919-3320966 Fax: +1-434-2431673
Received: May 29, 2018
Peer-review started: May 29, 2018
First decision: June 6, 2018
Revised: July 6, 2018
Accepted: July 14, 2018
Article in press: July 15, 2018
Published online: October 18, 2018
Processing time: 142 Days and 15.4 Hours
Abstract
AIM

To investigate whether adductor canal nerve block (ACB) reduces patient falls when compared to femoral nerve block (FNB) after total knee arthroplasty (TKA).

METHODS

We conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease.

RESULTS

A total of 834 patients had TKA with femoral nerve block and knee immobilizer (FNB + KI). Of those patients, 11 (1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one (0.13%) patient fall was recorded within this group. We used the Fisher’s exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance (P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were male.

CONCLUSION

Given the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.

Keywords: Reducing falls; Adductor canal nerve block; Total knee arthroplasty; Femoral nerve block; Costly falls

Core tip: When compared to femoral nerve block, adductor canal nerve block (ACB) contributed to fewer patient falls after total knee arthroplasty (TKA) at our institution from a rate of 1.3% to 0.13%. We also discovered a significant increase in fall rate after right TKA as compared to a left TKA. We recommend ACB as the preferred regional analgesia for the TKA procedure.